Abstract
The aim of this study was to examine if edrophonium provocative testing is useful for evaluating upper gastrointestinal hypersensitivity in patients with nonulcer dyspepsia (NUD). A questionnaire rating dyspeptic symptoms was done for 58 patients with NUD. The patients were then given an intravenous infusion of saline followed by 5 mg of edrophonium. Baseline esophageal manometry was also done. Patients whose usual symptoms were reproduced (48.3%) had significantly higher symptom scores (13.0 [8.5, 17.0] vs. 8.5 [6.0, 11.0]; P = 0.015) and a significantly higher number of symptoms (4.0 [2.5, 6.0] vs. 3.0 [1.0, 4.0]; P = 0.010) than patients whose usual symptoms were not reproduced. The presence of an esophageal motility disorder was not significantly different between the two groups. These findings suggest upper gastrointestinal hypersensitivity in the patients whose symptoms were reproduced. Edrophonium provocative testing might be useful for evaluating upper gastrointestinal hypersensitivity in patients with NUD.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Handa M, Mine K, Yamamoto H, Tsutsui S, Hayashi H, Kinukawa N, Kubo C (1999) Esophageal motility and psychiatric factors in functional dyspepsia patients with or without pain. Dig Dis Sci 44:2094–2098
Mine K, Kanazawa F, Hosoi M, Kinukawa N, Kubo C (1998) Treating nonulcer dyspepsia considering both functional disorders of the digestive system and psychiatric conditions. Dig Dis Sci 43:1241–1247
Handa M, Mine K, Yamamoto H, Hayashi H, Tsuchida O, Kanazawa F, Kubo C (1999) Antidepressant treatment of patients with diffuse esophageal spasm: A psychosomatic approach. J Clin Gastroenterol 28:228–232
Lin Z, Eaker EY, Sarosiek I, McCallum RW (1999) Gastric myoelectrical activity and gastric emptying in patients with functional dyspepsia. Am J Gastroenterol 94:2384–2389
Leahy A, Besherdas K, Clayman C, Mason I, Epstein O (1999) Abnormalities of the electrogastrogram in functional gastrointestinal disorders. Am J Gastroenterol 94:1023–1028
Parkman HP, Miller MA, Trate D, Knight LC, Urbain J-L, Maurer AH, Fisher RS (1997) Electrogastrography and gastric emptying scintigraphy are complementary for assessment of dyspepsia. J Clin Gastroenterol 24:214–219
Suzuki T, Yamamoto Y, Abe K, Hirano M, Oka H (1999) Sulfamethizole capsules containing contrast medium for assessment of gastric emptying in functional dyspepsia. Dig Dis Sci 44:1741–1749
Wilmer A, Cutsem E, Andrioli A, Tack J, Coremans G, Janssens J (1998) Ambulatory gastrojejunal manometry in severe motility-like dyspepsia: Lack of correlation between dysmotility, symptoms, and gastric emptying. Gut 42:235–242
Rhee PL, Kim YH, Son HJ, Kim JJ, Koh KC, Paik SW, Rhee JC, Choi KW (2000) Evaluation of individual symptoms cannot predict presence of gastric hypersensitivity in functional dyspepsia. Dig Dis Sci 45:1680–1684
Klatt S, Pieramico O, Guethner C, Glasbrenner B, Beckh K, Adler G (1997) Gastric hypersensitivity in nonulcer dyspepsia—Inconsistent finding. Dig Dis Sci 42:720–723
Lémann M, Dederding JP, Flourié B, Franchisseur C, Rambaud JC, Jian R (1991) Abnormal perception of visceral pain in response to gastric distension in chronic idiopathic dyspepsia: The irritable stomach syndrome. Dig Dis Sci 36:1249–1254
Malagelada J-R (1994) Conscious perception of gut activity. Dig Dis Sci 39:51S–53S
Bradette M, Pare P, Douville P, Morin A (1991) Visceral perception in health and functional dyspepsia: Crossover study of gastric distension with placebo and domperidone. Dig Dis Sci 36:52–58
Richter JE, Hackshaw BT, Wu WC, Castell DO (1985) Edrophonium: A useful provocative test for esophageal chest pain. Ann Intern Med 103:14–21
Speilberger C, Gorsuch R, Lushene R (1970) Manual for the State Trait Anxiety Inventory. Consulting Psychologists Press, Palo Alto, CA
Troshinsky ME, Castell DO (1994) Achalasia. In Castell DO, Castell JA (eds) Esophageal motility testing, 2nd ed. Appleton & Lange, Norwalk, CT, pp 109–121
Castell DO (1994) The nutcracker esophagus, the hypertensive lower esophageal sphincter, and nonspecific esophageal motility disorders. In Castell DO, Castell JA (eds) Esophageal motility testing, 2nd ed. Appleton & Lange, Norwalk, CT, pp 135–147
Rokkas T, McCullagh AM, Owen WJ (1992) Acid perfusion and edrophonium provocation tests in patients with chest pain of undetermined etiology. Dig Dis Sci 37:1212–1216
Dalton CB, Hewson EG, Castell DO, Richter JE (1990) Edrophonium provocative test in noncardiac chest pain: Evaluation of testing techniques. Dig Dis Sci 35:1445–1451
Bonapace EB, Parkman HP, Fisher RS (1998) Edrophonium provocative testing during electrogastrography (EGG): Effects on dyspeptic symptoms and the EGG. Dig Dis Sci 43:1494–1500
Bassotti G, Imbimbo BP, Betti C, Erbella GS, Pelli MA, Morelli A (1991) Edrophonium chloride for testing colonic contractile activity in man. Acta Physiol Scand 141:289–293
Bassotti G, Chiarioni G, Imbimbo BP, Betti C, Bonfante F, Vantini I, Morelli A, Whitehead WE (1993) Impaired colonic motor response to cholinergic stimulation In patients with severe chronic idiopathic (slow transit type) constipation. Dig Dis Sci 38:1040–1045
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tsutsui, S., Mine, K., Handa, M. et al. Edrophonium Provocative Testing for the Evaluation of Upper Gastrointestinal Hypersensitivity in Patients with Nonulcer Dyspepsia. Dig Dis Sci 51, 1302–1306 (2006). https://doi.org/10.1007/s10620-005-9063-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-005-9063-3